Over the past three decades, several approaches to preventing alcohol, tobacco, and drug

abuse in young people have been developed and implemented. Most of these prevention
approaches take the form of programs designed to be implemented in middle or junior high
schools because schools offer access to youth during the period of time when they typically
initiate substance use. Traditionally, these programs have involved the dissemination of
information about substance use and the negative health, social, and legal consequences of use
and abuse. Despite the fact that simply providing students with factual information about
drugs is ineffective in changing behavior, it remains the most commonly used approach to
prevention. However, information dissemination approaches are slowly being replaced by
more effective strategies that focus less on didactic instruction regarding the adverse health of
drug abuse and more on interactive skills training techniques. The most effective programs
teach children and adolescents social, cognitive, and behavioral skills using key principles of
behavior modification and focus on how to apply these skills to the developmental challenges
young people face, including the issue of drug use initiation.

DESCRIPTION OF THE STRATEGY

Over the past two to three decades, the focus of adolescent drug abuse prevention
programming has shifted as knowledge concerning the etiology of drug abuse has
accumulated. The most promising contemporary approaches are conceptualized within a
theoretical framework based on the etiology of drug abuse and relevant psychological theories
of human behavior. Effective prevention approaches can be grouped into two general
categories: (1) social resistance approaches and (2) competence enhancement or life skills
approaches.

Social Resistance Strategies

According to the social resistance skills approach, adolescent drug use results from a variety
of social influences, including the direct modeling of drug use behavior, particularly that of
peers, and persuasive advertising appeals and media portrayals encouraging alcohol, tobacco,
and other drug use. Therefore, social influence programs focus extensively on teaching youth
how to recognize and resist pressures to use drugs using a variety of resistance skills training
exercises. The goal of these exercises is to have students learn ways to avoid high-risk
situations where they are likely to experience pressure to smoke, drink, or use drugs, as well
as acquire the knowledge, confidence, and skills needed to handle social pressure in these and
other situations. These programs frequently included a component that makes students aware
of pro-drug influences in the media, with an emphasis on the techniques used by advertisers to
influence consumer behavior. Also, because adolescents tend to overestimate the prevalence
of drug use, social resistance programs often attempt to correct normative expectations that
nearly everybody smokes, drinks alcohol, or uses drugs. In fact, resistance skills training may
be ineffective in the absence of clear social norms against drug use because adolescents are
less likely to resist if the norm is to engage in drug use.

Competence Enhancement Strategies

A limitation of the social influence approach is that it assumes that young people do not want
to use drugs but lack the skills or confidence to refuse social influences promoting use. For
some youth, however, using drugs may not be a matter of yielding to peer pressure, but
instead may have instrumental value; it may, for example, help them deal with anxiety, low

self-esteem, or a lack of comfort in social situations. According to the competence

enhancement approach, drug use is conceptualized as a socially learned and functional
behavior that is the result of an interplay between social and personal factors. Drug use
behavior is learned through a process of modeling, imitation, and reinforcement and is
influenced by an adolescent's pro-drug cognitions, attitudes, and beliefs. These factors, in
combination with poor personal and social skills, are believed to increase an adolescent's
susceptibility to social influences in favor of drug use.
The most effective competence enhancement approaches to drug abuse prevention emphasize
the teaching of generic personal self-management skills and social coping skills in
combination with social resistance skills training. Examples of the kind of competence skills
included in this prevention approach are decision-making and problem-solving skills,
cognitive skills for resisting interpersonal and media influences, skills for enhancing selfesteem (goal-setting and self-directed behavior change techniques), adaptive coping strategies
for dealing with stress and anxiety, general social skills (complimenting, conversational skills,
and skills for forming new friendships), and general assertiveness skills. The most effective
way to teach these skills is by using cognitive-behavioral skills training methods: instruction
and demonstration, role playing, group feedback and reinforcement, behavioral rehearsal (inclass practice), and extended (out-of-class) practice through behavioral homework
assignments.

RESEARCH BASIS
While evaluation research has clearly shown that information dissemination approaches to
drug abuse prevention are ineffective in changing behavior, there have been many studies
showing that social resistance skills programs and competence enhancement programs are
generally effective. A comprehensive review of resistance skills studies published from 1980
to 1990 reported that the majority of prevention studies (63%) had positive effects on drug use
behavior, with fewer studies having neutral (26%) or negative effects on behavior (11%); and
several studies finding no effects had inadequate statistical power to detect program effects.
Furthermore, several follow-up studies of social resistance skills interventions have reported
positive behavioral effects lasting for up to 3 years. Longer-term follow-up studies have
shown that these effects gradually decay over time, suggesting the need for ongoing
intervention or booster sessions.
A number of evaluation studies have tested the efficacy of the competence enhancement or
life skills approach to drug abuse prevention. These studies have demonstrated behavioral
effects on smoking, alcohol, marijuana use, as well as the use of multiple substances and
illicit drugs. The magnitude of these effects has typically been relatively large, with some
studies showing reductions in drug use behavior in the range of 40% to 80%. Long-term
follow-up data indicate that the prevention effects of these approaches can last for up to 6
years. Furthermore, recent studies have shown that competence enhancement approaches are
effective with a broad variety of youth, including predominantly White samples in suburban
and rural settings as well as predominantly Black and Hispanic samples in urban minority
samples. Overall, the strongest behavioral effects across studies have been found when
programs are delivered with high integrity by trained providers and when booster sessions are
provided to reinforce the material after the initial intervention.

RELEVANT TARGET POPULATIONS

Contemporary programs are typically categorized into one of three types:universal programs
focus on the general population, such as all students in a particular school; selective programs
target high-risk groups, such as poor school achievers; and indicated programs are designed
for youth already experimenting with drugs or engaging in other high-risk behaviors. The
majority of school-based prevention programs are universal programs that focus on middle or
junior high school children, and a smaller number of programs focus on elementary school
children. The goal of these primary prevention programs is to prevent substance use before it
begins by impacting risk factors associated with the early stages of drug use. By preventing
drug use with younger populations (e.g., elementary and junior high school students), it is
presumed that this will ultimately reduce the prevalence of drug abuse among these youth
during later adolescence and early adulthood.
In addition, some drug prevention programs have been developed for high school and collegeaged populations. Most of these are selective or indicated interventions that target students
with poor academic records and those at high risk of dropping out of school, or those students
who are already involved in drug abuse and other behavioral problems.

CASE ILLUSTRATION
This section describes an example of an effective universal drug abuse prevention program,
called Life Skills Training (LST), which combines elements of both social resistance and
competence enhancement approaches. The LST approach is a universal intervention in that it
is designed for all individuals in a given setting rather than a selective or targeted intervention
that is only for individuals at high risk. The middle school version of LST is typically
provided in school classrooms in fifteen to seventeen 45-minute sessions. In addition to the
initial year of intervention, there are 2 years of booster intervention designed to reinforce the
material covered during the first year, including 10 booster sessions in Year 2 and five
sessions in Year 3. Below is a brief description of the major components of the LST program.

Program Components
Personal Self-Management Skills
The personal skills component of the LST program is designed to impact on a broad array of
self-management skills. To accomplish this, the personal skills component contains material
to (a) foster the development of decision making and problem solving (e.g., identifying
problems, defining goals, generating alternative solutions, considering consequences), (b)
teach skills for identifying, analyzing, and resisting media influences, (c) provide students
with self-control skills for coping with anxiety (e.g., relaxation training) and anger/frustration
(e.g., inhibiting impulsive reactions, reframing, using self-statements) and (d) provide
students with the basic principles of personal behavior change and self-improvement (e.g.,
goal setting, self-monitoring, self-reinforcement).
Social Skills
The social skills component is designed to impact on several important social skills and
enhance general social competence. This social skills component contains material designed
to help students improve general interpersonal skills such as how to overcome shyness and
how to give and receive compliments. This material emphasizes the teaching of (a)
communication skills, (b) general social skills (e.g., initiating social interactions and

conversational skills), (c) skills related to dating relationships, and (d) verbal and nonverbal
assertive skills.
Drug-Related Information and Skills
This component is designed to impact on knowledge and attitudes concerning drug use,
normative expectations, and skills for resisting drug use influences from the media and peers.
The material contained in this component is similar to that contained in many psychosocial
drug abuse prevention programs that focus on the teaching of social resistance skills. Included
is material concerning the (a) short- and long-term consequences of drug use, (b) knowledge
about the actual levels of drug use among adolescents and adults in order to correct normative
expectations about drug use, (c) information about the declining social acceptability of
cigarette smoking and other drug use, (d) information and class exercises demonstrating the
immediate physiological effects of cigarette smoking, (e) material concerning media pressures
to smoke, drink, or use drugs, (f) information concerning the techniques used in tobacco and
alcohol advertisements to promote the use of these drugs, along with skills for resisting these
influences, and (g) techniques for resisting direct peer pressure to smoke, drink, or use drugs.

Prevention Methods
The LST program is taught using cognitive-behavioral skills training, facilitated group
discussion, classroom demonstrations, and traditional didactic teaching methods. Much of the
material in the LST program is most effectively taught by facilitating group discussion and
through skills training, although lecturing and conventional didactic teaching methods are
appropriate for some of the material. Because the major emphasis of the LST program is on
the teaching of general personal self-management skills, social skills, and drug resistance
skills, the most important intervention method is skills training. The cognitive-behavioral
skills in the LST program are taught using a combination of instruction, demonstration,
behavioral rehearsal, feedback, social reinforcement, and extended practice in the form of
behavioral homework assignments.
Instruction and Demonstration
The first step in the skills training process involves instruction and demonstration. Instruction
involves explaining a particular skill to students in a careful step-by-step fashion, along with a
clear explanation of when to use the skill. Demonstration involves showing students how to
perform a particular skill. This can be done by the program provider, by videotape, or even by
a member of the class who has already learned the skill being taught.
Behavioral Rehearsal
Once the skill has been explained and demonstrated by the LST provider, students are given
the opportunity to practice the skill themselves through selected behavioral rehearsal
scenarios. To practice the skills, students can take turns coming to the front of the classroom
to participate in a brief role play that requires that they use the skill being taught. The class
can also be divided into small groups, with the program provider circulating from group to
group to observe the students practicing. The behavioral rehearsal scenarios are first described
by the provider or a small group leader, and the exercises are kept as brief as possible (a
minute or less each) so that as many students as possible can have a chance to participate.

Feedback
After students rehearse the skills being taught, they are provided with feedback concerning
the strengths and weaknesses of their skills performance. The teacher or program provider
conveys this information in a supportive manner so students understand what aspects of the
skill they performed well and what needs improvement. It is important that students are given
specific recommendations concerning how to improve. Emphasis is placed on constructive
feedback designed to guide students as they strive to improve and successively approximate
mastery of the skills being taught.
Social Reinforcement
Since the primary objective of the LST program is to reduce risk for drug abuse, the goal of
the skills training is to improve the target skills and self-efficacy of each student. Therefore,
students are assessed individually with respect to improvement over their own baseline levels,
however low. During and after the behavioral rehearsal exercises, the teacher or LST program
provider reinforces each student for one or two positive elements of his or her performance of
the skill. Although at times this may be a challenge, the program provider can simply identify
the most positive element of the student's performance.
Extended Practice
The purpose of extended practice is to provide opportunities for additional practice of the
target skills outside the classroom, in an effort to promote skill development and utilization.
This is accomplished through behavioral homework assignments, which may include tasks
such as practicing a new technique for coping with anxiety once a day or using an assertive
response in three different situations that arise during a particular week. In addition to
providing opportunities for practice in general, extended practice is intended to facilitate the
use of new skills in situations outside the classroom and encourage students to use these skills
in their everyday lives.
In summary, the most effective contemporary strategies for prevention of drug abuse among
children and adolescents focus less on didactic instruction about the adverse consequences of
drug abuse and more on interactive skills training techniques that aim to enhance social,
cognitive, and behavioral skills using key principles of behavior modification.
Gilbert J. Botvin and Kenneth W. Griffin
Further Reading

Entry Citation:
Botvin, Gilbert J., and Kenneth W. Griffin. "Drug Abuse Prevention Strategies."
Encyclopedia of Behavior Modification and Cognitive Behavior Therapy. 2007. SAGE
Publications. 15 Apr. 2008. <http://sage-ereference.com/cbt/Article_n2043.html>.